This section will provide you with all forms and policies needed to apply for high risk insurance with Arkansas CHIP. Applications should be mailed to CHIP Administrator, P.O.Box 1460, Little Rock, AR 72203.
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- Federal/Resident Application and Worksheet
- Newborn of Policyholder: Federal Resident Application and Worksheet
- Outline of Coverage
- Conditional Pre-Existing Waiver
- Endorsement re End of Coverage, Claim Filing Deadlines, Pre-Existing Condition Exclusion Limitation
- Endorsement re Eligibility, Prohibition of Certain Third Party Payments
Health Coverage Tax Credit (HCTC) Eligible
- HCTC Application and Worksheet
- Newborn of Policyholder: HCTC Application and Worksheet
- HCTC Policy
- HCTC Outline of Coverage
- HCTC Conditional Pre-Existing Waiver
- HCTC Policy Endorsement re of Coverage, Claim Filing Deadlines